The role of the state hospital: A new mandate for a new era

We are fast approaching a centennial of New York State's institutional system, the anniversary of the State Care Act of 1980. This can be evaluated against another important anniversary; the quarter century mark of the current convulsion/revolution of the mental hygiene care system of the entire United States, commonly referred to as deinstitutionalization.The state institutions, which for the past century were built up and maintained as the major locus of care for the chronically mentally ill, no longer occupy that central place in many localities. Yet these hospitals must continue to struggle with overwhelming burdens. Their inpatient populations, although now much smaller, still include many seriously mentally ill patients as well as the essentially non-dischargeable elderly.¹ In addition, they must provide for young adults with a new profile of difficult behavior and challenging demands.² This article is an attempt to redefine the role of the state institution in what has become the new era of community care, and to suggest fruitful new directions for the future which incorporate a contemporary shift in focus: from the concept ofillness to that ofdisability, and from a reliance on afacility or specificprogram to the development of a comprehensive and integratedsystem of treatment and support services.     

The limits of general hospital care: a continuing role for state hospitals

An examination of the characteristics of patients transferred to a state hospital after their treatment in a rural community general hospital had failed provides some data for defining the state hospital's role in relation to such patients. Of 2,128 discharges from the general hospital in a three-year period, 33, or 1.6 percent, were referred to the state hospital. The patients could be divided into four subgroups: violent patients, unresponsive patients with severely disorganized mental states, dependent patients treated successfully but referred because of a lack of community residential facilities, and deteriorating alcoholic recidivists who had proved to be unresponsive to treatment. At follow-up, the most improvements had occurred among the unresponsive subgroup. The author believes that, among those subgroups, state hospitals are most useful for violent patients, for deteriorating recidivist alcoholics, and, depending on further research, possibly for unresponsive patients.     

State-university collaboration: Role of the psychiatric hospital medical director

Medical directors are clinician-executives who provide leadership to advance state-university collaboration programs, and to facilitate recruiting and empowering a professional staff in the public sector. This article examines the medical director's role and tasks from the perspective of a social systems clinician who interacts with medical staff, hospitals, agencies, and university systems to meet oversight responsibilities and promote organizational development.     

Psychiatric research: The role of the state

Psychiatric research is as exciting as any field in health science today. But it will require support from a variety of sources if it is to achieve its potential.Two main points bear emphasizing in any overview of current mental health research. First, of course, is the vitality and significance of the work itself, and second is the multifaceted issue of support. This presentation will review briefly the various component parts on which this country's mental health research establishment is based: funding from the federal government; the crucial role of the individual state; and contributions of various other sections of our society to the overall research effort. This overview will also consider some of the secondary results of research support within the state.     

Beyond state hospital unitization: the development of an integrated mental health management system

As commissioner of the Massachusetts Department of Mental Health, the senior author in 1975 initiated a reorganization of the department designed to provide greater continuity of care for deinstitutionalized patients by integrating management of hospital and community services at a local level. The new system continued the practice of dividing hospitals into units corresponding to geographical catchment areas (unitization), but it abolished the hospital superintendent's position and greatly broadened the role of the area directors of community services to include clinical administration of the hospital unit serving patients in catchment areas. The authors believe the new system played a role in reorienting the department's services toward community care of the seriously disabled patient and led to a more effective distribution of departmental resources.     

The future of the state mental hospital

The author reviews the status of the state mental hospital and the chronic mental patient within the psychiatric service system and then examines the hospital's evolution from a systems perspective. She predicts that the state mental hospital will survive as an integral part of the service system, that it will be one of several loci of care for the chronic mentally ill, and that it will continue to experience financial and identity crises in the near future. She considers it essential that the state mental hospital be seen not as a facility of last resort but as one of many agencies that meet the varied needs of the chronic mentally ill.     

The changing role of the mental health organization

Citizens groups which are organized throughout the country for promoting mental health care have been enormously effective since WWII in stimulating the growth of community treatment facilities and in increasing the sources of monetary support. The treatment services now available, however, have met a roadblock of inadequate manpower. Since success will depend upon the quantity and quality of mental health manpower, this problem must be the next major one to solve. Professional channels are generally alert to this problem, and, for the most part, are diligent in their efforts to recruit and train new personnel. The people to be trained, however, are now a part of the general population and largely out of reach of the professionals. Citizens groups could prove to be most effective in the future if they now began to direct their attention toward: (a) recruiting young people at the high school and college level to go into the mental health professions, and (b) exerting an organized, systematic taxpayer's kind of pressure on state legislatures and training centers to improve, expand, or inaugurate training facilities. Some ideas on specific ways of doing this are proposed.This paper represents a summary of a report presented to the Washington County (Maryland) Mental Health Association, November 1964.     

The future of CMHCs: The role of the state

The author contends that the new de-institutionalization is masking the inability of states to establish clear authority and responsibility for the mentally ill. The determination of authority and responsibility was fatally flawed by the community Mental Health Centers Act when it did not clarify the state's role. Also discussed is how the withdrawal of direct federal funds affected community mental health center services.     

No place else to go: the changing role of state hospitals and forensic mental health services

Current trends in forensic mental health services and how they are used are shaping the future of state hospitals and mental health systems.